Credentials Clerk - GPI - Cleveland, OH (Contractor Brooke Army Medical Center (BAMC) at Fort Sam Houston, TX)
(2025-11)
- Process applications and reappointment paperwork
- Collect and process verification and accreditation information
- Maintain and update accurate databases for both privileged and non-privileged providers
- Detailed review of 2700 non-privileged providers' packets
- Perform qualitative analysis to ensure accuracy of both privileged and non-privileged providers
- Detailed review of current request of itemized privileges against those held previously and primary source verify all documents
Risk Management Coordinator - Baptist Health System - San Antonio, TX
(2024-06 - 2025-10)
- Manage and disseminate incident reporting for seven (7) facilities with accurate emails for appropriate units for review, approximately 100-600 emails daily
- Manage SafeSite destruction of medical records based on Records Retention rules and regulations
- Prepare response to Board of Nursing and Medical Board
- General Supervision of Assistant Patient Safety Analyst to ensure accuracy of legal documents
- Assist Risk Manager with Claims process and correspondence with attorneys to include gathering medical records, Policies, surveillance, radiology, etc.
- Daily clerical functions to include daily, weekly and monthly report analysis
Risk Management Specialist - MH Systems - Kansas City, KS (Contractor for Wilford Hall Ambulatory Surgical Center (WHASC) at Lackland AFB San Antonio, TX)
(2022-11 - 2024-03)
- Review and route medical files in accordance with Department of Health Agency (DHA) directives
- Advise and assist the clinical leadership in developing responses to allegations of medical malpractice
- Ensured quality of care (QOC) with standard of care (SOC) determination are conducted for all significantly involved providers
- Coordinate, assemble and manage risk management case files
- Create claims files and gather clinical data for QOC reviews
- Sequester Medical Records as indicated in the claim of potential compensable event (PCE)
- Prepare official certified mail
- Coordinate provider's memorandums for records, rebuttals and references staying within the guidelines of DHA and Air Force policy for healthcare risk management activities
- Investigated allegations to check validity and recommend actions to minimize risk
- Arranged risk management team meeting by preparing materials, updating calendars and setting up conference spaces
Risk Management Office Coordinator - BSA Health System LLC - Amarillo, TX
(2019-12 - 2022-04)
- Responsible for organization and efficiency of the Office of Risk Management and Patient Safety
- Provided coordination and submission of insurance claims and applications for 43 facilities
- Investigated all possible lost medical devices to include medications and reimbursed after verification of positive control
- Assisted in in data collection and submission of TX Nursing Board and TX Medical Board inquiries
- Provided administrative support to staff members, assisting with daily tasks as needed to promote productivity across the organization
- Assisted with the hiring process, conducting interviews and onboarding new employees to promote company culture
- Managed company-wide complaints and subpoenas alongside legal teams and risk management staff
- Oversaw maintenance requests for office equipment, ensuring prompt repairs or replacements as needed to prevent downtime
- Managed budgeting process for office expenses, tracking expenditure to ensure compliance with financial guidelines
- Oversaw office inventory activities by ordering and requisitions and stocking and shipment receiving
- Managed supervisor itinerary and appointments and streamlined scheduling procedures
Patient Account Representative-Remote - Marshall Health Pediatrics - Huntington, WV
(2016-10 - 2018-03)
- Collect, enter, and process primary and/or secondary claim information on departmental cycle
- Submitted claims and managed follow-up with various insurance carriers on unpaid or rejected claims
- Ensured Insurance verification and authorizations obtained are within the correct dates of service
- Answered Office Managers and/or responsible party inquiries on account status and charges, such as patient responsibility, copays, deductibles, and write-offs
- Followed up with insurance carrier(s) on unpaid and or rejected claims
- Resolved issues and re-submitted claims as needed
- Monitored explanation of benefits received for charges not covered by insurance and applied payment posting
- Worked with outside entities to resolve issues with billing, claims, and payments
Ambulance/Fleet Services Administrative Assistant-Temp - University Health System - San Antonio, TX
(2015-08 - 2016-03)
Temporary Agent with Robert and Half Account Temps' contract with University Health System.
- Verify and correct an average of 56 Ambulance Run Reports daily
- Abstract primary diagnosis for correct and concise billing. Clarify ALS and BLS according to CMS guidelines
- Invoice insurances for payment of ambulance runs for each month
- Aided in the implementation, training, proper coding, and correct documentation needed for Novita's STRAC ICD-10
- Aided in the updating of the Physician Certification Statement based on Novita's STRAC ICD-10
- Assisted planning and execution of a fund-raising event for United Way 2015
- Assisted in monitoring the maintenance and repair of sixty-two vehicles to contract vendors for service and repair as needed
- Trained my replacement
